Mallory-Weiss syndrome differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Mallory-Weiss syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Mallory-Weiss_syndrome]]
{{CMG}} {{AE}} {{DM}}
{{CMG}}; {{AE}} {{DM}}
 
{{PleaseHelp}}


==Overview==
==Overview==
Line 10: Line 8:
==Differential Diagnosis==
==Differential Diagnosis==
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:<ref name="pmid7812643">{{cite journal |vauthors=Sutton FM, Graham DY, Goodgame RW |title=Infectious esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=4 |issue=4 |pages=713–29 |year=1994 |pmid=7812643 |doi= |url=}}</ref>
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:<ref name="pmid7812643">{{cite journal |vauthors=Sutton FM, Graham DY, Goodgame RW |title=Infectious esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=4 |issue=4 |pages=713–29 |year=1994 |pmid=7812643 |doi= |url=}}</ref>
* [[Reflux esophagitis]]: Ulcerations are usually in distal esophagus, and maybe irregular and multiple, unlike Mallory-Weiss syndrome. Patients have history of heartburn and regurgitation.
<small>
* Infectious esophagitis: Ulcerations are multiple and usually involve the proximal esophagus.
* Medication-induced esophagitis: Ulcerations are usually singular and deep with a history of drug use such as tetracycline.
 
Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
*  [[Peptic ulcer|PUD]]
* [[Variceal bleeding|Esophagogastric varices]]
* [[Gastritis|Severe or erosive gastritis/duodenitis]]
* [[Angiodysplasia]]
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Reflux esophagitis
| style="padding: 5px 5px; background: #F5F5F5;" |
* Ulcerations seen in reflux esophagitis are usually in the distal esophagus also observed in Mallory-Weiss syndrome.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Ulcerations are usually in distal esophagus, and maybe irregular and multiple, patients have history of heartburn, dysphagia and regurgitation that distinguish it from Mallory-Weiss syndrome.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Infectious esophagitis
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* Ulcerations are multiple and usually involve the proximal esophagus that distinguish it from Mallory-Weiss syndrome.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Medication-induced esophagitis
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* Ulcerations are usually singular and deep with a history of drug use such as tetracycline that distinguish it from Mallory-Weiss syndrome.
|-
 
|}
 
===Preferred Table===
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="7" |History and Symptoms
! colspan="8" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Physical Examination
! colspan="3" |Laboratory Findings
! colspan="3" |Laboratory Findings
Line 64: Line 24:
!History of medication
!History of medication
!Vomiting
!Vomiting
!History of alcoholism
!Tachycardia
!Tachycardia
!Skin Pallor
!Skin Pallor
!Hypotension
!Hypotension
!Weak pulse
!Weak pulse
!CBC
!Hemoglobin
!Platelets
!Platelets
!BUN
!BUN
Line 79: Line 40:
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
Line 84: Line 46:
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
|-
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| -
| style="background: #F5F5F5; padding: 5px;" | -
| +
| style="background: #F5F5F5; padding: 5px;" | +
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" | -
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually in distal esophagus, and maybe irregular and multiple
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually in distal esophagus, and maybe irregular and multiple
|}
</small>
Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="6" |History and Symptoms
!
!
! colspan="4" |Physical Examination
! colspan="3" |Laboratory Findings
! rowspan="2" |Upper endoscopy
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Hematemesis
!Epigastric pain
!Retching
!History of alcoholism
!Light-headedness
!history of cirrhosis
!NSAIDs use
!''Helicobacter pylori'' infection
!Tachycardia
!Hypotension
!Skin Pallor
!Weak pulse
!CBC
!Platelets
!BUN
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mallory-Weiss syndrome
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |PUD
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Esophagogastric varices
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |The varices may be in the esophagus and/or the stomach.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Severe or erosive gastritis/duodenitis
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Angiodysplasia
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |small, flat, cherry-red lesions with a fern-like pattern
|}
|}



Latest revision as of 22:21, 7 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:[1]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Light-headedness Retching Heartburn History of medication Vomiting History of alcoholism Tachycardia Skin Pallor Hypotension Weak pulse Hemoglobin Platelets BUN
Mallory-Weiss syndrome + + + (with heavy bleeding) + - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
Infectious esophagitis - + - - - - - - - - - - Ulcerations are multiple and usually involve the proximal esophagus
Medication-induced esophagitis - + - - - + - - - - - - Ulcerations are usually singular and deep
Reflux esophagitis - + - - + - - - - - - - Ulcerations are usually in distal esophagus, and maybe irregular and multiple

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:[2][3][4][5]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Retching History of alcoholism Light-headedness history of cirrhosis NSAIDs use Helicobacter pylori infection Tachycardia Hypotension Skin Pallor Weak pulse CBC Platelets BUN
Mallory-Weiss syndrome + + + + + - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
PUD +/- + - +/- - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
Esophagogastric varices + + +/- + + - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> The varices may be in the esophagus and/or the stomach.
Severe or erosive gastritis/duodenitis + + +/- - - +/- - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
Angiodysplasia + + - - +/- - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> small, flat, cherry-red lesions with a fern-like pattern

References

  1. Sutton FM, Graham DY, Goodgame RW (1994). "Infectious esophagitis". Gastrointest. Endosc. Clin. N. Am. 4 (4): 713–29. PMID 7812643.
  2. Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB (2004). "The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated". Gastrointest. Endosc. 59 (7): 788–94. PMID 15173790.
  3. Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G (2008). "An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium". Gastrointest. Endosc. 67 (3): 422–9. doi:10.1016/j.gie.2007.09.024. PMID 18206878.
  4. Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
  5. Wollenman CS, Chason R, Reisch JS, Rockey DC (2014). "Impact of ethnicity in upper gastrointestinal hemorrhage". J. Clin. Gastroenterol. 48 (4): 343–50. doi:10.1097/MCG.0000000000000025. PMC 4157370. PMID 24275716.


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